From the Guidelines
Sodium chloride supplements should be discontinued when serum sodium levels return to normal range (135-145 mEq/L) or when the patient's hyponatremia has resolved, with careful consideration of the patient's clinical symptoms, fluid status, and underlying cause of hyponatremia, as recommended by the most recent guidelines 1.
Key Considerations for Discontinuation
- Monitoring serum sodium levels regularly during treatment, with measurements every 4-6 hours in severe cases or daily in less urgent situations, is crucial to avoid overcorrection and mitigate the risk of osmotic demyelination syndrome (ODS) 1.
- The rate of sodium correction should not exceed 8-10 mEq/L in 24 hours to avoid ODS, a serious neurological complication 1.
- Once sodium levels stabilize within normal range for 24-48 hours and the underlying cause of hyponatremia has been addressed, supplements can be safely discontinued, but patients should be monitored for 1-2 days after stopping supplements to ensure sodium levels remain stable 1.
Underlying Cause Considerations
- The decision to stop supplementation should also consider the patient's clinical symptoms, fluid status, and whether the original cause of hyponatremia (such as medication effects, SIADH, or volume depletion) has been adequately treated, as emphasized in the guidelines 1.
- Abrupt discontinuation without addressing the underlying cause may lead to recurrence of hyponatremia, highlighting the importance of a comprehensive approach to management 1.
Recent Guideline Recommendations
- The most recent guidelines from 2021 recommend a goal rate of change of serum sodium of 4-8 mEq/L per day, not to exceed 10-12 mEq in a 24-hour period, with average ODS risk and a lower goal of 4-6 mEq/L per day, not to exceed 8 mEq per 24-hour period in patients at high risk of ODS 1.
- These guidelines also emphasize the importance of individualized care and consideration of the patient's specific circumstances, such as urgency for transplant, severity of hyponatremia, and local expertise 1.
From the Research
Stopping Sodium Chloride Supplementation in Hyponatremia
- The decision to stop sodium chloride supplementation in hyponatremia depends on various factors, including the severity of hyponatremia, the rate of correction, and the presence of symptoms 2.
- In patients with severe hyponatremia (<120 mmol/l), sodium chloride supplementation should be continued until the serum sodium concentration reaches a safe level, typically above 125 mmol/l 3.
- However, rapid correction of hyponatremia can lead to osmotic demyelination syndrome (ODS), a rare but severe condition 4, 5.
- To avoid ODS, the rate of sodium correction should not exceed 8-12 mmol/l within 24 hours 5.
- In patients who have developed ODS, re-lowering of serum sodium to a level just below the maximal target value at 48 hours may be beneficial 6.
- The use of sodium chloride supplementation should be individualized and monitored closely to avoid both undercorrection and overcorrection of hyponatremia 2, 3.
- Hourly oral sodium chloride supplementation can be an effective and predictable treatment for severe hyponatremia, especially in patients who cannot receive intravenous 3% NaCl 3.